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In combat, soldiers encounter stress from multiple sources including loss of sleep, extremely high levels of physical and psychological discomfort, extended periods of increased vigilance, and intense danger. Therefore, it is imperative to train such personnel on how to cope with these stressors. One way to do this is to include stressors in different forms of training to acclimate soldiers to the subsequent stress of combat. Due to their advantages, tactile trainers are being investigated increasingly for the use of training Army medics in this context. The present work examines how vibrating tactile sensors, or tactors, can be used as surrogate sources of stress on an operator performing a simulated medical task. This work also examines how this "optimal" configuration interacts with other types of stress, such as noise and time pressure. The outcome findings support the hypotheses that configurations placed on sensitive body areas are more stressful than those placed on more benign body locations in terms of worse task performance on a tourniquet application task. In terms of application times, the same trends persist in terms of proper application, subjective stress and subjective workload, as well as a secondary monitoring task, in terms of response times, accuracy, and time estimation. Additionally, findings supported hypotheses that the stress responses experienced order tactile stress alone is compounded when other types of stress are employed, both on the primary and secondary tasks. These results have implications for training, such that if stressors are employed in training, performance decrements might be lessened during actual task performance; they can be generalized to not only combat medics, but other military specialties and civilian jobs that incur vibration, auditory stress, and time pressure while engaged in performance.

Every year, approximately 3000 people die as the result of physical trauma in Sweden (Gedeborg, Chen, Thiblin, & Byberg, 2012). Many of these deaths occurs outside of the hospital and are preventable, including some caused by hemorrhage. One hemorrhage control device is the tourniquet which can be used in a civilian pre-hospital setting. The effects of stress on a laypersons tourniquet application ability is unknown and to date only one study have examined the effects of stress on tourniquet application in a military population (Schreckengaust, Littlejohn, & Zarow, 2014). The purpose of this study was to investigate how the performance of two first aid interventions, tourniquet application and cardiopulmonary resuscitation (CPR), is affected by stress in immediate (layperson) and first (professional) responders. A total of 55 participants followed a brief educational program about hemorrhage control. Their ability to apply a tourniquet and perform CPR was tested in a calm classroom scenario and a stressful scenario, which consisted of paintball fire and an obstacle course. Stress was assessed through subjective reports of stress, physiological heart rate and heart rate variability measurements, and subjective workload and with a secondary task. The results showed differences of elicited stress reaction between the conditions and groups. Tourniquet and CPR performance was moderately affected by stress. Participants across all groups experienced more stress reactions during the stressful scenario, and laypersons did experience more stress reactions than professional first responders. In conclusion, the method did make participants experience more stress reactions in terms of psychological, physiological and performance adaptations in the stressful scenario. However, the results need to be replicated and a list of suggested improvements are given, such as: examining the fidelity of the scenarios, validating the tourniquet application assessment method, and examining the relationship between tourniquet application performance and self-assessed performance.

Educating medical laypeople in first aid for massive bleeds improves the injured person’s chance of survival when they act as an immediate responder. Although research has been done on different stressors that affect the medical laypeople’s first aid ability, the effect of cold remains unexplored. Cold has been found to decrease finger dexterity and could hence have a negative effect on the first aid ability. This study investigates the potential effect of cold on medical laypeople’s tourniquet application ability and their experienced stress. The results show that 8 degrees C hand-skin temperature significantly increases the total time and time until bleeding control is achieved. Cold exposure can decrease the chance of survival for the injured person when an immediate responder provides first aid for a massive bleed. Future research should therefore be aimed at finding suitable mitigation strategies for the effect and testing their viability in the presence of additional stressors.

Ischemia/reperfusion (I/R) injury causes extensive damage to skeletal muscle, often resulting in prolonged functional deficits. This current study determines the efficacy of controlled release of SDF-1α and IGF-1 by conjugation to biodegradable, polyethylene glycol, (PEG)ylated fibrin gel matrix in skeletal muscle repair of an I/R injury. Male Sprague-Dawley rats underwent a 2-hour tourniquet induced I/R injury on their hind limbs. Twenty-four hours post injury the following treatments were administered: PEGylated fibrin gel (PEG-Fib), SDF-1 conjugated PEGylated fibrin gel (PEG-Fib/SDF-1), or dual protein IGF-1 and SDF-1 conjugated PEGylated fibrin gel (PEG-Fibrin/SDF-1/IGF-1. Following 14 days after injury, functional and histological evaluations were performed. There was no significant difference in maximum tetanic force production recovery between PEG-Fib and PEG-Fib/SDF-1 groups. However, PEG-Fib/SDF-1/IGF-1 group resulted in significant improvement of force production relative to the other treatment groups. The same results were found for specific tension. Histological analysis revealed a greater distribution of small myofibers in the PEG-Fib/SDF-1 group than the PEG-Fib group, while the PEG-Fib/SDF-1/IGF-1 group had the smallest distribution of small fibers and similar to controls (uninjured). There were also a greater number of centrally located nuclei in the PEG-Fib/SDF-1 group than the PEG-Fib group, while the PEG-Fib/SDF-1/IGF-1 group had similar values to controls. Although these results confirm the protective role of exogenous IGF-1, SDF-1 did not have an effect on skeletal muscle repair. / text

I USA har blödningskit innehållandes bland annat tourniqueter, utrustning för avsnörande förband, placerats ut på allmänt tillgängliga platser för att civila ska kunna agera och stoppa blödningar. Denna studie utreder hur användningen av tourniqueter kan påverka förblödningar vid en potentiell skadehändelse. Det scenario som studeras är konstruerat, och behandlar en bombexplosion som sker vid ett evenemang i en stor arena med många besökare. Tourniqueter har placerats ut på olika platser i lokalen, och syftet är att utvärdera vilken eller vilka platser som skulle kunna vara lämpligast för denna utrustning. Studien behandlar hur en skadehändelse skulle kunna se ut, vilka faktorer som spelar roll vid lokalisering av tourniqueter, antal tourniqueter som ska finnas och var de ska placeras i det studerade scenariot, samt vilken effekt de olika placeringarna har på antalet omkomna. Metoden för studien är simulering, som utförs i programvaran Arena. För att bestämma lämpliga indata till modellen görs en kvalitativ kategorisering för de parametrar som ska ingå i scenariot. I studien framkommer bland annat att det är svårt att bedöma hur många som skadas vid en händelse, varvid en riskanalys för potentiella händelser med bland annat antalet skadade bör göras för att bestämma lämpligt antal tourniqueter för en plats. Resultatet från simuleringen visar att det inte är så stor skillnad på var tourniqueterna placeras i lokalen utan att det viktigaste är att det finns tillräckligt många personer som kan använda dem. Det finns i resultatet en tendens mot att en utspridd placering av tourniqueterna i lokalen är att föredra och att eventuella hinder som exempelvis evakuerande personer kan påverka möjligheten att snabbt hitta en tourniquet. Därför bör scenarioanalyser ingå i riskanalysen, där flaskhalsar identifieras och tas i beaktning vid planeringen av var tourniqueter ska placeras.

This paper examines the concept of safety as it encompasses the personal and technological spheres as imagined by a group of active duty service members, veterans, a police officer, and civilians, as well as the agency exercised by those with military or police backgrounds when it comes to safety technology. A group of seventeen individuals took part in a battlefield simulation to test a wearable junctional tourniquet created by ARMR Systems, LLC, an innovative advancement in tourniquet technology. After the simulation, participants were interviewed, surveyed, and took part in a focus group to determine not only product suitability but also to explore the underlying reasons for their recommendations for product changes. Results showed that those with military or police background performed safety rituals prior to duty and exercised agency in the desire to obtain the best possible personal safety devices and technology to be used for themselves and their comrade-in-arms. All participants expressed concerns for their safety in regards to technology in general, specifically, the hacking and use of personal data and what is perceived as lack of governmental oversight. Almost all of the changes to improve product safety, comfort, and utility were adapted. The topics discovered during the course of this research proves a need for safety product testing from an applied anthropological perspective.

Army first responders, specifically Combat Medics and Combat Lifesavers, provide medical intervention while in the field. Didactic as well as hands-on training helps to prepare these first responders, and one module they receive involves bleeding control. First responders are taught to use the Combat Application Tourniquet® (CAT® ) to stop bleeding from limbs subjected to severe injury such as amputation, gunshot, or severe lacerations. A training aid like the Multiple Amputee Trauma Trainer™ (MATT™) simulator provides tourniquet training using a lifelike bilateral lower limb amputee. In addition, MATT™ combines movement and resistance while the first responder applies the tourniquet, mimicking conditions one would see in a real situation. This research describes tourniquet history, appropriate usage, field tourniquet review, surgical tourniquet, CAT® bleeding intervention procedures, bleeding physiology and complications, prehospital tourniquet use in recent conflicts, medical simulation fidelity, and a review of the value of animatronic movement during tourniquet simulation-based training. I then evaluate the effectiveness of animatronic movement during tourniquet training using the Advanced MATT in an experiment using Army first responders. The control group experienced no movement while the experimental group experienced movement when applying a tourniquet during the lab-training. Each group then alternately experienced Advanced MATT movement during an immersive scenario along with fog, strobe lights, and battle sounds. It was hypothesized that 1) In the immersive scenario, the experimental groups (i.e., those who were trained on a moving simulator) would have a faster reaction time as compared to those participants who did not receive training on the moving Advanced MATT simulator; 2) In the iv lab-based training, the experimental groups would have a slower reaction time; 3) In the immersive scenario, the experimental groups would have a faster tourniquet application time when subjected to movement while in the lab-based training, but the experimental groups would also have a slower tourniquet application time when initially subjected to movement in the laboratory-based training; finally, 4, 5, and 6) Participants who completed lab-based tourniquet training on the Advanced MATT simulation with animatronic movement would report higher perceived realism scores than participants who complete the training on a static version of the Advanced MATT and participants who completed a tourniquet training immersive scenario on the Advanced MATT simulation with movement would report higher perceived realism, presence, and self-efficacy scores than participants who complete the training on a static version of the Advanced MATT. The empirical results show a significant overall training effect of the Advanced MATT simulator (with or without movement). For reaction time and tourniquet application time, involving simulator movement was significant over varying scenarios. A small reduction in reaction and tourniquet application time on the battlefield may be extremely beneficial on the battlefield. Participants who received movement generally gave more positive reactions than those who did not received movement, although these results failed to reach statistical significance. Participants who received movement, followed by a scenario without movement rated the subjective ratings the lowest, suggestive of the lack of movement. Furthermore, despite the order movement was received, no large drops in performance occurred in any condition, indicating that negative training was avoided

Bakgrund: Stasband är en medicinteknisk utrustning som används regelbundet vid intravenösa nålprocedurer, i syfte att minska det venösa återflödet. Stasband har beskrivits i tidigare forskning som en potentiell smittkälla. Syfte: Att belysa vårdhygieniska arbetsmoment och rutiner vid hantering av stasband vid intravenös nålprocedur. Metod: Studien utfördes som en allmän litteraturstudie baserat på sju resultatartiklar av kvantitativ och mixad metod. Resultatartiklarna granskades, analyserades och sammanställdes genom en innehållsanalys. Resultatet sammanfattades i fyra huvudkategorier. Resultat: Studiens resultat presenterades i följande huvudkategorier: Stasband som smittkälla, Rengöring av stasband, Val av stasband påverkar kontaminationen, Betydelsen av kunskap, rutiner och riktlinjer. Litteraturstudiens resultat visade att kunskap, rutiner och riktlinjer för hantering av stasband är av stor betydelse för patientsäkerheten. Konklusion: Sjuksköterskans kunskap och fortsatt utbildning är av betydelse för att medvetet arbeta preventivt mot smittspridning. Sjuksköterskan har ett ansvar för patientsäkerheten och ska uppmärksamma vårdgivaren om brister förefaller. Infektionsförebyggande arbete är ett delat ansvar mellan sjuksköterskan och vårdgivaren. / Background: A tourniquet is a medical device regularly used in intravenous needle procedures, with the aim of reducing venous return. Tourniquet has been described in previous research as a potential source of infection. Aim: To shed light on hygienic working steps and routines when handling tourniquet during intravenous needle procedures. Method: The study was conducted as a general literature study based on seven results articles of quantitative and mixed methods. The results articles were reviewed, analyzed and compiled through a content analysis. The results were summarized in four main categories. Result: The results of the study were presented in the following main categories: Tourniquets as a source of infection, Cleaning of tourniquets, Selection of tourniquets affects contamination, Importance of knowledge, routines and guidelines. The results of the literature study showed that knowledge, routines and guidelines for the handling of tourniquets are of great importance for patient safety. Conclusion: The nurse´s knowledge and continuing education are important for consciously working preventively against the spread of infection. The nurse has a responsibility for patient safety and must alert the care provider if deficiencies appear. Infection prevention work is a shared responsibility between the nurse and the care provider.

The number of prehospital deaths caused by large bleedings could be decreased if civilian people would act in time to help the injured patient. One way to help is to stop the bleeding with a tourniquet application. However, the tourniquet needs to be placed correctly in order to stop the bleeding. Therefore laypersons need to be educated in bleeding control to increase the rate of successful tourniquet application. This study used human error identification techniques such as Hierarchical Task Analysis and Systematic Human Error Reduction and Prediction Approach to identify possible errors of four commonly used tourniquet models: the CAT-7, Delfi-EMT, SAM-X and SWAT-T. The results show that many predicted errors are time-oriented and critical. Video analysis of tourniquet application was performed to map occurred use errors from the videos with the predicted ones. The goal was to identify problems that could be solved by training or redesigns of the tourniquets. The results show that the most common errors for all participants during tourniquet application were of six error types. The errors were to not check time or write down time of application, to take too much time to place the tourniquet around the limb, to place the tourniquet upside down, to place the tourniquet band over the securing mechanism instead of between and lastly to not secure the tourniquet correctly before transporting the patient. The untrained laypersons made more errors than the trained laypersons and professional emergency personnel group. The trained laypersons also made fewer errors in a calm setting than in a stressed setting, comparing to the professional group who did the same error types in both settings. The results indicate that untrained laypersons not only make more errors but also more critical errors than trained laypersons and professional emergency personnel. Future research should empirically test other tourniquet models than the CAT in the goal of finding use errors to be reduced. Overall the results are in line with previous studies that show the need for education of bleeding control techniques in the civilian population.